先天性胆管囊肿癌变与首次手术术式的关系探讨

Relationship between canceration and primary operation mode for congenital choledochal cyst

目的 探讨先天性胆管囊肿癌变与原手术术式的关系。方法 对近 30年来收治的 2 1例先天性胆管囊肿癌变患者的资料进行回顾性分析。结果 本组先天性胆管囊肿总癌变率 14 8% ;原手术为囊肿内引流术者的癌变率显著高于囊肿切除术 (P <0 .0 0 1) ;囊肿内引流术后患者癌变年龄显著小于囊肿切除术 (P <0 .0 1)和未手术者 (P <0 .0 1) ;囊肿内引流术后发生癌变的年限显著短于囊肿切除术 (P <0 .0 1) ;囊肿内引流术后癌变者的发病年龄比未手术者早 15 4年。结论 囊肿内引流术能加速和促进癌变发生 ,应废用 ;囊肿切除术应列为首选术式 ;囊肿应尽可能切净 ,不能切净者应剥除内膜或破坏其粘膜。

Objective To investigate the relationship between canceration and primary operation mode for congenital choledochal cysts(CCC). Methods The clinical data of 21 patients with CCC treated in the last 30 years were analysed retrospectively. Results In this series, the incidence of carcinoma was 14.8%; the canceration rate after internal drainage operation was significantly higher than that after resection of the cyst(P<0.001); the age of canceration after internal drainage was younger than that of resection of the cyst(P<0.01) and patients without operation(P<0.01); the interval time of canceration after internal drainage operation was significantly less than that of resection of the cyst(P<0.01); the age of carcinoma would be 15.4 years younger in internal drainage operation patients than that in patients without operation. Conclusions Internal drainage, which could accelerate the occurrence of canceration of CCC, should be abandoned; resection of the cyst is recommended as the therapy of the first choice.